Friday, October 19, 2007

CAM for HCV: case

Case

Scenario

One of the health professionals (HP) at Herzl comes to me asking that I meet with one of her patients (a young man) who has Hepatitis C and is resisting interferon. The HP tells me her patient is interested in complementary and alternative therapies (CAM). Although she would prefer that he accept the recommended treatment she is open to discussing alternatives with him. She hopes the young man's specialist will be open to exploring CAM treatments.

Resolution

When the young man meets with me I mention to him that since he is not sure about interferon a decision aide might help him decide. He hesitates but is amenable once I explain that the aid will not force him to decide one way or another but will rather give him a structure for clearing his thoughts. While we talk he shows me a link to a resource he has already accessed on the subject. It turns out to be a good resource, www.hepatitis-central.com, that has HONcode accreditation which is at present undergoing annual review.

The patient is very happy with what I have printed for him. In addition he would like to find some information about the use of vitamine C as a therapy, having heard that it can cure HCV completely. We look together and find a few references to vitamin C and HCV but I am not able to find anything definitive or evidence-based, although something is mentioned on Hepatitis Central that might be worth showing to his specialist. We discuss some criteria to use in order to judge whether a website can be trusted including: who maintains the site? who wrote the article? when was it updated? is the information cited?

Discussion

It remains to be seen whether the patient will decide to accept the interferon treatment or whether his specialist will be amenable to exploring CAM therapies.

About Info.Rx

Update:

In the fall of 2008 a Clinical Medical Librarianship component was added to the service. The librarian now acts as a resident supervisor in the teaching rooms at the clinic one half-day per week, providing support for clinical decision-making in addition to continued support for patient education.

The service is based on an innovative InformationRx model first implemented in the UK (see: Early experience of thecontribution of an information specialist within a primaryhealthcare team: a partnership venture betweenlibrary and healthcare services, doi: 10.1177/0961000604048915].

This model sees the information professional acting as a member of the health care team by providing informational/instructional support for patients/families and health professionals at point of care. Support for the service is provided by the main hospital library and is vital for ensuring long term sustainability.

The information professional is available 7 hrs per week to consult with patients/families that are in need of health information.

Health staff are encouraged to write InformationRx for patients which can then be filled by the information professional. Consultations with patients are treated as clinical encounters and are documented in the charts. The service has a clinic in the Centre's appointment scheduling software.

Patients and family members are welcome to drop in, or to submit questions by phone or email at their convenience. They can schedule appointments by contacting the information professional directly or by calling their team coordinator.

The library provides support by welcoming questions from patients and their families when the coordinator is not available. Herzl patients and families are able to borrow books from the Patient and Family Resource Centre's (PFRC) print collection, and a family medicine section has been created on the PFRC website which provides links to reliable and up-to-date consumer health resources.

Author"s note

Important: While based on real consultations, the cases posted in this blog have been mashed up, fictionalized, posted out of sequence, and otherwise tinkered with in order to maintain the privacy and comfort of the parties involved.

Also, the views and opinions expressed in this blog are strictly my own and do not necessarily reflect those of my employers.

About this blog

The Patient health Information Service at Herzl (H-PHIS) opened its doors in early July of this year (2007) and is in the early developmental stages. The challenges faced by myself (the service's coordinator), the staff, and the health care team at the HFPC are many and varied, as is to be expected when implementing a new and innovative service.

Perhaps the most unique aspect of the InfoRx model is the presence and participation of the information professional/librarian at point of care. This new and multidisciplinary approach presents a distinctive challenge. Health and support staff are not always clear on what knowledge and skills a librarian brings to the team. Conversely, I must be able to recognize and adapt to the needs and character of the community and of the setting itself.

This blog was created in response to some very astute and constructive criticism. After presenting to the residents at their weekly rounds, I was approached by one of the partners at the clinic who suggested that rather than introducing myself and the service and then explaining how to use it, it would have been more effective to present some cases illustrating what the service has to offer to the residents and to their patients. I see this as a perfect example of the kind of disconnect that can happen when two very different professions come together. In essence I had presented the way I would have to my own professional colleagues, but this was not the most appropriate approach given my audience.

After giving it some thought it occurred to me that it could be useful, both for myself and the rest of the team, for me to present a weekly case here, and talk about some of the challenges we are faced with and how these might best be resolved. Hopefully this will introduce some transparency to the InfoRx process.

This is meant to serve as a record of, and forum for discussion about, our challenges and successes. It is hopefully also an opportunity for other information professionals to be inspired by one example of what can be accomplished outside of the library setting.

About Me

Francesca Frati has an MLIS from Dalhousie University and is the wearer of many interconnected professional hats. She works at the SMBD Jewish General Hospital Health Sciences Library (HSL) as Patient Information Specialist and Instruction Librarian, at the Herzl Family Practise Centre (HFPC) as Patient Information Coordinator, and in her spare (work) time provides research support for physicians.
Francesca is a member of the advisory committee for the Society of Teachers of Family Medicine (STFM) Conference on Practise Improvement: "Blueprint for the Medical Home".